Another informative post by Lauren Riney, one of the excellent Pediatric Emergency Medicine Fellows at Cincinnati Children’s Hospital Medical Center.
When is ketamine ABSOLUTELY contraindicated?
- Age younger than 3 months (primarily for risk of airway complications)
- Schizophrenia (studies show this condition may be exacerbated with ketamine administration)
The list of relative contraindications is much longer:
- Anything that may increase the risk of laryngospasm (major procedures stimulating the posterior pharynx, active pulmonary infection such as URI, active pulmonary disease such has asthma)
- Anything that could be detrimental with enhanced sympathomimetic effect (porphyria, thyroid disease, HTN, heart failure, cardiovascular disease)
- History of airway instability, tracheal surgery, tracheal stenosis
- Increased ICP or intraocular pressure (CNS masses, hydrocephalus, glaucoma, or acute globe injury). Of note, head trauma is NOT a relative contraindication to ketamine. Newer evidence suggests that the cerebral vasodilatory effect may be cerebroprotective and the increases in pressure are minimal with normal ventilation.